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The attitude of the parents has also to be considered. An
established practice is difficult to alter. For years children have
been removed to hospital almost automatically, have received
excellent attention and the family has been relieved of much
dislocation of its routine which is necessary for securing effective
isolation in a private dwelling. Poor mothers cannot afford the
expense of practising effective isolation, and the retention of a
notifiable case at home frequently involves the breadwinner in
some restrictions to the detriment of his income.
The risk of cross infection in the multiple bed wards of our
isolation hospitals to-day cannot be denied. The reports of the
Chief Medical Officer to the Ministry of Health show that this
has been demonstrated conclusively. It is borne out in our local
experience by the fact that the Superintendent of the Joint Isolation
Hospital reports that the majority of "return" cases have been,
not from homes to which children have been discharged after only
one month's stay in hospital, but from houses where the original
case had been retained in hospital for periods of from 8 to 10 weeks.
Whether the present system of hospital treatment for scarlet
fever is being carried to excess or not, one practical means of eliminating
the risks of the existing practice is indicated quite clearly.
However many cases it is desirable to send to hospital, be it few or
many, they should be nursed on the cubicle system. It is more
costly certainly, but surely that is preferable to perpetuating a
system which in its faults tends to foster the dissemination of
infections which it is designed to prevent.
Diphtheria.
There was a further satisfactory fall in the prevalence of diphtheria
in the district, excluding Queen Mary's Hospital, although
the number of notifications from that institution showed an increase.
The total notifications numbered 105, of which 72 were in
respect of Queen Mary's Hospital and 33 from the rest of the
district. The incidence rates were—
Per 1,000
population.
All cases notified 1.78
Cases excluding Queen Mary's Hospital 0.57
(England and Wales) 1.58
The reduction in incidence is mostly in those age groups which
are affected by diphtheria immunisation, and in this connection it
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